The upcoming academic year will see many changes to the UNMC College of Medicine’s standard practices for residents and medical students, but faculty and college leaders have been working throughout the spring to make sure supports are in place as the COVID-19 pandemic continues to impact medical education.
Kelly Caverzagie, M.D., associate dean for educational strategy at UNMC, and Wendy Grant, M.D., associate dean for admissions and student affairs for the college, discussed some of the changes and challenges ahead as medical students return to the clinical environment later this summer.
“I don’t think that anything will ever be ‘business as usual’ again,” Dr. Caverzagie said. “COVID-19 has changed how we provide health care across the spectrum, and many of those changes will be long lasting.”
“Our students are resilient and strong,” said Dr. Grant, adding that administrators and faculty would meet with students to prepare them to return to the clinical environment.
Medical students return to the clinical environment
Everyone is excited for the medical students to return to the clinical environment, Drs. Caverzagie and Grant said, but the college is focused on student health and institutional transparency as M3s return on June 29 and M4s on July 6.
“We are working closely with the clerkship directors who run each of the six specialties and the Clinical Skills Training (CST) directors who run the fourth-year rotations to see what their needs are,” Dr. Grant said.
Since the M3s haven’t done any clinical rotations as a result of the pandemic, “we’re making sure we offer enough support to students and clerkship directors to get them onboarded pretty quickly,” she said.
An emphasis is that students feel safe and are aware of masking and PPE guidance.
“Will our students have many of the same experiences, objectives and expectations? Absolutely,” Dr. Caverzagie said. “We’re not changing medical school in that sense, but we are recognizing that the environment around them has necessarily changed. We anticipate that how students learn may change as well.”
He pointed to the health system’s transition of ambulatory business to telehealth and telemedicine during the pandemic as something that will continue – although balanced by more in-person visits – even as the pandemic recedes.
“I don’t think it’s going to go back to what it was pre-COVID,” he said. “So how do we prepare our students to both provide care using telehealth and learn using telehealth?”
Small group or cohort learning and studying may change because of social distancing rules or new health care regulations and guidelines.
“This is the new medicine,” Dr. Grant said. “We’ve worked hard to be ahead of the curve. Students would have liked to be back in clinical rotation sooner, but the everything was done with the students best interest at the forefront.”
The important thing, Dr. Caverzagie said, is students will be providing care for patients again.
“Our students will be prepared to learn and work in this new environment,” he said.
Residency matching
Disruption to the decades-long method in which medical students applied for, interviewed at and selected residency programs has been a struggle for every medical student across the country, Dr. Caverzagie said. “This is a tense and stressful process,” he said.
“The application process has been pushed back by two-to-four weeks, which allows students to do more rotations, even into October, to make decisions about career choices and get letters of recommendations,” Dr. Grant said.
Still, because of COVID-19, students are not going to be able to travel to other institutions to do rotations.
Since many students have been unable to do the rotations that normally would drive their residency choices, the college has done individual counseling to help students explore career choices, Dr. Grant said. College leaders will meet in July to discuss each individual student and explore how to help them achieve their career goals.
“Away rotations have been important for some specialties, as ‘audition/recruitment’ rotations,” Dr. Grant said. “Now, away rotations cannot happen, for obvious reasons, and that’s the situation nationally.”
Fortunately, she said, UNMC has residency programs for almost every specialty.
Additionally, the college is prepared to help students navigate virtual residency interviews – perhaps setting up a dedicated room on campus for interviews and helping students with how to best present themselves in an electronic format.
Still, there will be challenges. With all interviews virtual, residency programs may be flooded with applicants, Dr. Grant said, forcing them to rely on metrics such as test scores rather than examining students holistically.
USMLE Testing
The U.S. Medical Licensing Examinations occur in three steps: Step 1, Step 2 (clinical knowledge and clinical skills) and Step 3. All were dramatically disrupted by the pandemic.
“The testing either requires students to go to a testing center, here in Omaha or elsewhere, or, for the clinical skills exam, to travel to one of five cities across the country,” Dr. Caverzagie said. “The testing centers were shut down, causing students to reschedule the examinations – which is one of the more stressful things students do. To have it disrupted like this has been difficult.”
Dr. Grant said all the students at UNMC applying for residency this year had taken their Step 1 exams.
“The students who had Step 2 scheduled for April, May or June have had to adjust their preparation for the exam and be flexible,” she said. “They have had exams cancelled multiple times and many have traveled outside of Nebraska to take the exam.”
“The testing changes have been a challenging experience,” Dr. Grant said. “We advised all our students to take the exam in April, May or June, and they all planned their lives around getting this exam done. And then everything changed.”
The college has been working with students to schedule testing dates and has submitted a request to be a testing center, she said.
“This is happening to every student in the country, and we are supporting our students as best as we possibly can,” Dr. Caverzagie said. “Everyone is cared for and going to be OK. We do know that the Step 2 clinical skills exam, the one that requires travel, has been delayed for 12-18 months. For the rest of the exams, the National Board of Medical Examiners is working to mitigate effects on students, implementing multiple contingency plans, and actively working through challenges.”